Planning for Spontaneity: Music Therapy Session ...
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Lesley UniversityDigitalCommons@Lesley
Expressive Therapies Capstone Theses Graduate School of Arts and Social Sciences(GSASS)
Spring 5-19-2018
Planning for Spontaneity: Music Therapy SessionPreparation, Structure and ProceduresPeri StrongwaterLesley University, [email protected]
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Planning for Spontaneity:
Music Therapy Session Preparation, Structure and Procedures
Capstone Thesis
Lesley University
April 30, 2018
Peri Strongwater
Music Therapy
Jason D. Butler, PhD, RDT-BCT
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Abstract
Current research in the field of music therapy regarding productivity and efficiency is limited to
exploring theoretical concepts and is lacking on the effects of implementing said theories. It will
be advantageous for music therapists to adopt streamlined processes for recurring responsibilities
such as session planning, preparation and post-session processing. Increased productivity in
these endeavors will permit more time allocated towards more valuable undertakings. To expand
upon the emerging data and to contribute to the field’s current understanding, this writer has
designed a session structure model exclusively for music therapists to use in their clinical
practices. A worksheet-based template was found to be a productive method in which to
efficiently design session plans. Additionally, the template was useful as a processing tool to
support documentation, evaluation and organizational needs for treatment plan development.
Results indicated that using this template is a viable option for increasing preparedness and
efficiency before, during and after music therapy sessions. The positive consequences of using
the model suggest that music therapists may benefit from more succinct preparation and
processing practices and supports the need for future research.
Keywords: session plans, session planning, session structure, lesson plan, hello song,
goodbye song, ritual, professional skills, preparation skills, intervention design, program
development, time management
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Planning for Spontaneity:
Music Therapy Session Preparation, Structure and Procedures
Introduction
The intention of this thesis is to identify the recurring segments of music therapy session
planning, preparation and post-session tasks and integrate them into a concise template, as
guided by current literature and personal experiences of this writer. A deeper understanding of
pre-existing models in music therapy was needed before considering the elements necessary to
include in this system. Generally, an effective course of action would start with large-scale
program development, move to treatment plan development, then session planning and
intervention design. A treatment plan is an outlined agenda of interventions chosen to meet a
client’s needs, strengths and preferences. A session plan can be defined as a single session or
meeting between the individual or group and therapist, with time spend working towards the
clinical goals of the treatment plan. Session structure can be defined as the organizational
framework within sessions, and the similarities that can be found between sessions.
This thesis will focus on understanding the mechanisms supporting productive session
preparation and processing. The end goal is to have a final product representing a protocol
applicable to multiple populations, locations and clinical goals, to be used as a pre-session and
post-session tool. This will be especially beneficial for my work, as I am (at the time of writing)
working at multiple locations. The session planning template is to be used at all sites, including
my internship at a trauma-informed boarding school for adolescents, my music specialist
Program Development
Treatment Plan Session Plan Intervention
Design
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position at a geriatric hospital, and in leading multi-generational and early education music
programs. Another intention is to increase productivity by introducing shared systems connecting
all job locations. Regardless of population or location, all of my music therapy work can be
condensed to the following stages: planning and preparation, the music therapy session itself,
and post-session processing. Post-session processing includes recurring procedures such as
reflection, documentation and follow-up communication.
Another function of session planning is to allow space and opportunities for creativity
and spontaneity. For therapists, reviewing occurrences and observations from in-session work
may lead to information regarding which environmental or clinical elements best supported their
client in their creative expression or facilitated a meaningful moment. The nature of music
therapy represents the constant cycle between creative, free-form work in the here-and-now and
thoughtful, intentional or controlled practice. Music therapy work often emphasizes creativity,
improvisation and the significance of the present, contrasting the concept of music therapy as a
systematic process. As a structured experience, “music therapy is purposeful, temporally
organized, methodical, knowledge-based, and regulated” (Bruscia, 1998a, p. 26). Music therapy
is both imaginative and regulated. The experiences and interventions may be designed and
control by the music therapist, but one cannot plan for unpredictable moments of expression and
illumination. As music therapy is goal-oriented, every choice made by the clinician must have a
purpose and work towards achieving client goals. Music, as a standalone occurrence, is the
organization of sound over time. Similarly, a music therapy session is the organization of
musical experiences in a structured, time-based setting. This inquiry will examine the elements
and variables that construct sessions, and will consider theories of structure and organization
within and adjacent to the field.
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Literature Review
This review will highlight the current literature as it pertains to the topic of session
planning and session structure in music therapy and related fields. The literature review will
begin with a theoretical alignment to provide foundation for the research question of identifying
and organizing elements within and between music therapy sessions, then will compare
utilizations of structure in the fields of mental health counseling, education and music therapy.
This literature review will conclude with examining common internal components and external
elements of music therapy sessions.
Foundation
One philosophical perspective of the importance of structure is discussed by Beer (1990)
through discussing the significance of ritual. Ritual is identified as the repetitions of an action,
and the changes that occurs within repetition. Moving between repetition and innovation
provides the structure in which clinical work occurs. Routines provide “a sense of security and
familiarity, feelings essential for any in-depth work. The routine becomes a flexible structure
within which possibilities for change and newness are endless” (Beer, p. 39). When designing a
session plan, one must remember that the structure isn’t set in stone, variations will occur
naturally. The choice of when to enact a ritual precisely as planned or to deliberately change will
depend on the client’s needs.
Similarly, Wheeler et al. (2005) provide general guidelines for organizing session plans
while emphasizing that the ability to adjust prepared plans and accommodate changes in session
is essential.
Many music therapists follow a basic three-part sequence: (a) some type of warm-
up or introductory experience, (b) one or more experiences comprising the main
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part of the session, and (c) a closing or wrap-up experience. Following this
structure provides a dependable framework that can be comforting to clients, can
contribute to the meaning of the therapy session, and can help the therapist
achieve consistent outcomes. (p. 108)
Although many variations will be found across differing methods, most session structures can be
reconsidered to fit this model, identifying opening, main portion, and closing experiences.
Mental Health Counseling
Similar to the three stages of beginning-middle-end, the RUC helping process model also
consists of three stages; known as Relating, Understanding, and Changing (Nelson-Jones, 2002).
These stages are illustrative of both the overarching treatment process and the individual
sessions. The Relating stage occurs before session and at the beginning of session, when the
counselor focuses on building and maintaining the therapeutic relationship. Understanding is the
main time spent in session, where the client and counselor assess and agree on the client’s goals.
Changing includes preparing the client to manage current problems out of session and the
termination process.
Nelson-Jones (2000) also developed a model outlining four phases within individual
counseling sessions, based on the Changing stage of the RUC helping process model. The first
phase, Preparing, includes evaluating previous sessions, consulting with colleagues, preparing
helping strategies, ensuring on-time arrival and setup. Next, the Starting phase includes meeting
and greeting, re-establishing the relationship and establishing session agendas with the client.
The middle phase is comprised of Coaching, made up of client involvement and delivering
helping strategies. Last in the Ending phase, which includes review of progress, discussion of
future application and dismissal. Although these stages are based on traditional talk therapy,
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without utilizing music or arts-based interventions, these stages demonstrate similar
phenomena’s in music therapy due to the shared significance of developing a therapeutic
alliance, and the utilization of pre-planned interventions to achieve treatment goals.
The music therapy treatment process is reminiscent of traditional psychotherapeutic
models, generally understood as consisting of three basic steps; assessment, treatment and
evaluation (Wheeler et al., 2005). This process can be divided further to include Referral,
Assessment, Treatment plan development (definition of goals and objectives), Treatment,
Documentation, Evaluation and Termination (Davis et al., 2008). Another model for treatment
plan development was provided by Parsons (1986) and consists of seven steps;
1. Complete assessment
2. Identify client’s clinical needs and problems
3. Set long-term goals
4. Set objectives
5. Plan appropriate interventions
6. Write progress notes
7. Review and evaluate
Although, Parsons’ method was designed for adult psychiatric patients outside of music therapy
settings, the steps generated are applicable to other populations and therapeutic modalities as
well. Again, this paper will focus on the treatment stage, specifically the individual sessions
when the therapist meets with the clients. It is important to note that although these writers are
speculating as to what a productive therapy session contains, there is yet to be research that
measures said productivity. Future research is needed to support these theoretical concepts of
structure in mental health counseling.
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The ARC (Attachment, Regulation and Competency) model for treating adolescents who
have experienced trauma indicates the importance of building routine into therapy sessions
(Blaustein & Kinniburgh, 2010). A sample talk therapy session plan includes an opening check-
in, a modulation activity, a structured activity, a “free choice” activity and a closing check-out.
The opening check-in is an opportunity for the client to report their current mood or recent life
updates. The purpose of the modulation activity is to regulate the energy levels of the client,
supporting a stable affect. The structured activity would be the main goal-oriented component of
the therapy session, followed by an opportunity for the client to demonstrate decision-making
abilities and feel empowered. The check-out ritual may include another modulation activity,
cleaning up session materials or verbally processing current emotions. The ARC model is used to
guide practice by all clinicians at Pelham Academy, the internship placement of this writer.
Observations indicated that only the “check-in” and “check-out” interventions are used regularly
by all clinicians, while the other activities are utilized depending on client needs.
Education
Although music therapy and music education are two separate fields, similarities will be
considered in support of the research question. Music therapists and teachers both develop plans,
coordinate resources, facilitate experiences, support change, and attain goals. Thus, the expanse
of curriculum and lesson plan research available may support the development of music therapy
session design. The Hunter Model, a popularly used lesson plan template, includes seven
elements to be used in any order;
• Objectives
• Standards
• Anticipatory set
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• Modeling
• Guided practice
• Closure
• Independent practice (Wolfe, 1987)
Objectives are similar to clinical goals, every lesson plan and every session plan needs to serve a
purpose - although that purpose may not necessarily need to be communicated to clients,
depending on the population. Anticipatory set is when the teacher gathers the students’ attention
and focus, which is also important in music therapy. Modeling and guided practice in education
is when new information is presented and students are given the opportunity to apply what they
have learned. This may be compared to the middle sections in music therapy, where the goal-
oriented interventions occur.
Another lesson plan model (Cunningham, 2009) outlines eight phases;
1. Introduction
2. Foundation
3. Brain activation
4. Body of new information
5. Clarification
6. Practice and review
7. Independent practice
8. Closure
In the introduction phase, a purpose is set and communicated to the students, and students
regulate in order to pay attention. The foundation phase is a time for checking on previous
knowledge and clarifying questions. This may be beneficial in the therapeutic session to draw
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connections to previous sessions. In phases three through seven, students are engaged and active,
then given an opportunity to practice on their own, a useful opportunity to prepare students for
future work. These activities parallel the active engagement phases of music therapy sessions, or
the client-chosen activity of the ARC model. The closure phase is when information is reviewed,
summarized and connected. Other key elements of this lesson plan model include time allotment,
supply list, resource information and predetermined questions – all elements relevant to the
therapeutic process.
The Music Together (Guilmartin & Levinowitz, 2010) lesson planning model for early
education music teachers outlines several guidelines for music classes, some mandatory and
some flexible. All classes must begin with the hello song ritual, followed by a song meant to
focus children’s attention. The next few activities can vary, generally including instrumental
play, seated movement and large movement. There is always a high-energy free-choice
instrumental play-along song, followed by a soothing lullaby. Every Music Together class ends
with the ritual goodbye song. This lesson plan template is designed to support energy building
through the first three-quarters of the class time, with peak energy occurring during the play-
along song, and energy ebbing during the lullaby and goodbye song. Although this model is
designed for music education purposes, the use of ritual and observation of energy levels
demonstrate applicability to clinical environments.
Structure in Music Therapy
Many of the various branches of music therapy theory have their own approaches to
structure within the music therapy process. Three major approaches within the music therapy
field include psychodynamic music therapy, Bonny guided imagery and music (GIM) and
Nordoff-Robbins’ Creative Music Therapy. In psychodynamic music therapy, clients explore
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their conscious and unconscious problems, as similar to psychodynamic and psychoanalytic
therapy practices. Musical experiences are used to facilitate the therapeutic process. In a
psychodynamic music therapy session there is no outlined structured, but there are seven main
methods for song selection, including song performance, song improvisation, induced song
recall, song communication, and song writing. Therapists draw from these categories to decide
the structure of a psychodynamic music therapy session (Bruscia, 1998b). In the specialized
technique of GIM, trained music therapists facilitate active music listening experiences for their
clients with the intention of allowing images, symbols and deep emotions to arise from the
unconscious (Nolan, 1983). Four stages make up GIM sessions, which generally range from 90-
120 minutes;
1. Preliminary conversation to establish rapport
2. Induction, for relaxation to support concentration
3. Music listening period
4. Integration and review of experiences (Bonny, 1978)
In Nordoff-Robbins music therapy, associated largely with early childhood and/or autism
spectrum populations, a typical 30-minute session usually begins with a musical greeting song as
the child is transitioning into the room, Then, the music therapist engages in an improvisatory
music-creation phase based on the child’s movements and responses with the intention of
creating a shared musical experience with the child. Then, the therapist may use precomposed
piece of music designed and chosen to meet therapeutic goals. Nordoff-Robbins sessions
typically close with a goodbye song (Guerrero & Turry 2013) Nordoff-Robbins sessions may
also be considered as a three-part process; opening song, musical activities, and closing song
(Beer, 1990).
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Regardless of the foundational approach, session plan structures will be largely
depending on the client population. For example, Frisch (1990) suggests that highly structured
musical activities are helpful for psychiatric adolescent populations, as strengthening impulse
control is a common goal for many patients in this population. She suggests striving for a
balance between allowing for freedom of choice and expression within carefully constructed
guidelines. Too little structure can result in high levels of anxiety in psychiatric patients, thus
leading to detrimental behaviors. She also reports that over -structuring a session may also be
unproductive.
If the therapist projects an over-controlling quality or requires rigid adherence to
rules and directions, marked reluctance to attend the music therapy session and
resentment toward the therapist may follow. Achieving a balance within the
session between freedom and limit setting, direction and nondirection, is essential.
The patients’ reactions and behaviors will reflect the state of balance or imbalance
(p. 25).
It is important to note that there were no research findings indicating that an over-structured can
be unproductive beyond conceptualizations, similar to the lack of research measuring
productivity. Conceptual claims have been made, but a current weakness in this field is the
limitation of quantitative research looking at beneficial or detrimental additions to therapy
sessions. At this time, there were no studies of effectiveness in using these models.
A model presented by Weissman (1983) outlined the structure for planning music
activities specifically for seniors in long-term care facilities. Thirty musical activities were
assessed for their relationship to treatment goals of the following categories; sensory, perceptual-
motor, cognitive, physical fitness, self-image and social. The model identifies a six-step
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framework for planning individualized music activity programs. The second step has been
expanded in support of the research question.
1. Determine purpose
2. Design individualized music activity programs
• Identify client’s needs
• Determine goal(s) of the intervention
• Determine behavioral objectives / output displayed by client
• Choose a musical activity to support behavioral outcome
• Identify what actions to be observed.
3. Plan for implementation
4. Plan for evaluation
5. Observe and record
6. Evaluate the program (p. 65)
This model is more fitting for an aging population, who may not be as capable as verbal
processing, or may not require as much freedom for creative expression, as previously mentioned
adolescent psych patients.
Pellitteri (2000) describes a model for group sessions with children in special education
as having ideally 4-8 participants, seated in a circle. Sessions follow the typical three part
structure of starting with a hello song to support transitions from earlier activities, and ending
with a goodbye song to provide closure. Time between this established structure is spent on
musical activities such as playing instruments, singing or moving. Activities are chosen by the
music therapist to meet the clinical goals of the participants.
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Stephens (1984) identifies a four-part session structure as her model, designated for
improvisational group music therapy sessions with adults. The first component is the warm-up,
in which members arrive and group cohesion is promoted. The next stage is for verbal
discussion, followed by the main phase and ending with closure. Gardstrom (2007) expanded on
Stephens’ model, outlining an eight-step session structure specific to verbal, adult groups
partaking in improvisational interventions.
1. Introductory Discussion
2. Verbal Check-In
3. Sound Vocabulary (introduction to instruments + musical information)
4. Warm-Up Improvisation
5. Brief Discussion
6. Core Improvisation Experience
7. Verbal Processing
8. Verbal of Musical Closure (p. 78)
Analyzing and comparing the identified structures within existing music therapy models is
beneficial to understanding the elements considered in pre-session preparation, in-session
structure and post-session processing. Further research in comparing and contrasting elements
will be examined in the next section.
Common Elements in Music Therapy Sessions
Previously discussed structure patterns in music therapy and related fields have varied
depending on the foundational approach or needs of the population served. However, there are
some universal considerations that span population-based approaches, regardless of site or
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location. Literature providing information regarding elements, variables and factors within
music therapy sessions will be reviewed next.
Hadsell (1993) identified six elements of external structure in music therapy sessions,
which are time, space/equipment, choices, materials, instructions and activities. These six
elements are present in all music therapy sessions. Hadsell also notes that three levels of
structure – maximum, moderate, and minimum – can be applied to the elements of external
structure. Again, the amount of structure is specific to the client, environment and purpose.
Wheeler et al. (2005) also identified valuable common considerations for designing a
music therapy session, including identifying;
• what is important for the client(s)
• what the client(s) can gain from a music therapy session
• feelings or reactions towards the client(s)
• how music can help or support the process
• what ethical concerns may arise
Two main questions are indicated for music therapists to ask themselves when planning sessions,
“What do I do to meet the needs of the client? … naturally leadi[ing] to the questions: How do I
do what is required to meet the clients needs?” (p. 97). Additional variables to be considered in
this planning process include identifying the following needs; medical, physical, environmental,
musical, communication and emotional. Other environmental factors include deciding what to do
regarding room arrangement, equipment, instruments and materials. Further considerations for
session structure will be dependent on the population and location, but will tend to include client
diagnosis, personality, developmental level and needs.
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Music therapists from Aalborg University outlined four steps to a music therapy session;
focus attention, regulate arousal level, dialogue and conclusion (Ridder & Mette, 2004).
Attention is focused through the use of hello songs if working with children, or using a song to
provide contextual cues to orient the client. The purpose of the beginning stage of session is to
establish a structure through stability and cues. After focusing attention, the music therapist
regulates the client’s arousal level to moderate, with the function of maintaining attention
throughout session. Interventions in this phase are chosen to either stimulate or calm the client.
Only after clients are focused and regulated can dialogue begin. Dialogue is the phase in which
psychosocial needs are addressed. The intention of the final concluding phase is to provide
stability and security, ensuring the client will transition appropriately out of session.
As discussed, “hello songs” and “goodbye songs” are often used in music therapy to open
and close sessions. These songs provide non-verbal cues to facilitate inclusion, establish a
musical environment, establish therapeutic contact, promote musical communication, focus
attention and minimize anxiety during transitions (Kantor & Kruzikova, 2016). Hello songs are
regularly used in Nordoff-Robbins creative music therapy and developmental therapy with
children, but the ritual of using a song as an opening to focus attention, orient client to time and
place and regulate energy is often used with older populations, especially in group settings. In a
treatment program for middle-school and high-school students with emotional and behavioral
disorders, hello songs are used at the beginning of every session to provide each student an
opportunity to express their current mood, to establish group cohesion, and to permit therapists
and teachers an opportunity to assess each participant (Sausser & Waller, 2006). Although a
hello song is often clinically chosen as an opening ritual, it is important to note that the popular
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phrase “hello song” does not necessarily mean a song or involve salutations, but may also be
used as an opportunity for improvisation or verbal processing (Wheeler et al., 2005).
Clinical improvisation, previously mentioned as one of the four main intervention
categories in music therapy, is the act of spontaneously creating musical materials for a
therapeutic benefit and is commonly utilized by most working music therapists regardless of
population or location. However, the amount of structure and organization given to an
improvisation varies depending on the needs of clients, to parallel the elements considered in
structuring a session timeline. One model (Beer, 2011) outlines improvisation design on a
spectrum, with one end representing unrestricted improvisation and the polar end as highly
structured improvisation. In an unrestricted improvisation, no time limit is set, goals may include
exploration or supporting self-esteem. In a highly structured musical activity, clear instructions
and parameters are communicated, and goals may include impulse control or practicing social
skills. Other factors identified for improvisational intervention design are determining group or
individual, age of client(s), client backgrounds, physical abilities or deficits, environmental
restrictions, degree of psychosis or other mental illness, level of chaos, attention span, goals,
trust or group cohesion, instruments available and time constraints. These elements, here
described as variables of intervention design, are also important consideration when determining
session structure. Furthermore, this model establishes guidelines for setting up improvisation
interventions, including the following:
1. Setting the physical environment
2. Creating an atmosphere of trust and safety
3. Create an experience geared towards needs and interests
4. Give verbal instructions
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5. Decide to meet the client’s energy or present alternative
6. Establish a relationship in the music
7. Work
8. Closure
9. Notes/Planning (p. 125)
Beer recommends using time immediately following session to write notes, revise goals and
notate musicals phrases/chords to be introduced in later sessions.
These methods collectively shape theoretical evidence attesting to the significant
presence of structure within music therapy sessions. The general three-step approach described
by Wheeler et al. (2005) provides a flexible framework by which other models may be adapted
or perceived. Essential elements to be considered when implementing a collective structure,
include the elements of external structure (Hadsell, 1993), needs of the client (Wheeler et al.,
2005) and variables of intervention design (Beer, 2011). Both the macro stages of session
structure and the determining micro factors will be considered when designing and implementing
a session template to be utilized in clinical music therapy work.
Methods
To expand upon the emerging data and to contribute to the field’s current understanding
of session structure and productivity, a session template was designed and assessed through the
following methods. The only participant was this writer, a music therapy graduate student at
Lesley University. The template was designed with the intention to suit individual and group
sessions in multiple locations with various populations, and were utilized at Pelham Academy
(this writer’s internship site, a trauma-informed therapeutic residential school), Newbridge on the
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Charles (one of this writer’s work sites, a chronic care geriatric hospital) and Strongwater
Studios (this writer’s early childhood music education business) from 2/7/18 to 4/15/18. Tested
templates were reviewed after use, and I kept records of my responses. Reflections were made on
the usefulness, applicability, and challenges of the session template. Progress was tracked using
a clinical log and the online program WorkFlowy. Additional data was gathered in the form of
handwritten reflections on separate unused printed templates. These findings were used to make
edits between upgrades. At time of writing, there were four templates used, referred to
henceforth as Template 1.0, 2.0, 3.0 and 4.0.
Session templates were designed using Microsoft Word and Google Docs, and were
printed onto white 8.5” x 11” paper. The template was one sided for easiest access and reference,
and was made to be concise and minimal, so a quick glance during sessions would suffice for
information gathering as not to disrupt session flow. The session template was printed, and then
details pertaining to the clients, goals and interventions were written in by hand during the
session planning process.
Information gathered from the literature review was summarized in a single table, to
better understand the theoretical divisions of session structure (See Appendix A, Theoretical
Model Comparison). The components of nine models were categorized into Wheeler’s (2005)
three generalized sections; beginning, middle and end, labeled in the template as introduction,
middle and closing. Further reductions were made in best efforts to reframe and condense
session elements into a concise format. The first template (see Appendix B, Session Plan
Template 1.0) provided space for the following sections.
• Introduction
o Opening (Hello Song / Ritual)
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o Check-In
o Warm – Up / Regulation
• Middle
• Closing
o Check Out / Integration
o Closing Ritual
The session template also included space for the following pre-session information: location,
population, client(s), age, date/time, location, diagnosis, goals, preparation, and materials. At the
bottom of the template was a section for noting the date and time when attendance or progress
notes had been submitted, and to provide a place for a signature. Signing this template signifies
that the session and all proceeding steps have been completed to this writer’s utmost ability.
Future designs of the template (2.0, 3.0 and 4.0) are variations of this first version and can be
referenced in Appendix C, D and E.
Results
Session Template 1.0 was used seven times over four days, for four individual sessions
and three group sessions, from 2/7/18 to 2/11/18. While using the template, I started thinking
about my sessions in a different way, drawing connections between populations and locations
that I hadn’t noticed before. Although I used opening and closing rituals in many of my sessions
previously, I was now making sure to include them consistently in all sessions, and keeping a
better track of time to ensure enough time for the closing rituals. Feedback from clients was
positive surrounding opening and closing rituals. Surprisingly, I found myself jotting down notes
after sessions right onto the work sheet, finding it was a quick and easy way to review session
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until I had the time to sit down for proper documentation of progress notes. This unexpected
positive outcome influenced this thesis tremendously, moving the concentration away from
session planning specifically, instead looking at the larger systemic process, understanding the
repetitive tasks within a music therapist’s workload with the intention of increasing efficiency.
Within my workload, this included weekly occurrences such as writing progress notes, taking
attendance at larger groups at the hospital and writing reports to my supervisor.
Therefore, Template 2.0 (see Appendix C) included more space for notes to use for pre-
session preparation and post-session processing. For example, a client asked me to learn a new
song I had never heard before, and I was able to write down the title, Tumbalalaika for later
referencing. Template 2.0 outlined the following structure for session planning, removing the
categorizing column (intro, middle, closing) to save space as the divisions can be easily assumed;
opening ritual, regulation / check-in / warm-up, main section, check-out and closing ritual (See
Appendix C).
Session Template 2.0 was used eight times from 2/14/18 to 2/17/18, for three individual
sessions and five group sessions. It included a condensed information section to allow more
room for session plan and notes sections. This was achieved by removing population, age and
diagnosis, as this information is easily available in the client’s digital charts. Also, I decided that
I wanted the template to be “safe” for client’s eyes, meaning they should be able to view the
sheet, ask questions, or even make changes depending on the clients. This was implemented after
reviewing my data responses, and noting that two of my individual clients at Pelham and one of
my private lesson students had taken interest in the template, which had been kept on a clipboard
off to the side. I reflected on how I didn’t want the template to feel like a secret, especially at
Pelham, where the adolescent clients are often very involved in their own treatment and clinical
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goals. However, not all clients are aware of or accepting of their diagnoses, so I removed the
diagnosis section. Again, this information is easily accessible in the digital charts. Space was
also gained by merging the “Preparation” and “Materials” section, since they often overlapped.
The Goal section remained as a reference for session planning, but only client-friendly goals
were recorded. Lastly, a space for post-session notes was added to include room for additional
plans and next steps. Some samples of post-session notes from the data collection include
prepare C / Em chord printout and deliver to J.G, discuss incentive plan with primary clinician
and prepare/print lyrics for D.W. As predicted, this was especially useful for referencing before
future sessions. For example, I am only at the geriatrics hospital once a week, and it can be
difficult remembering all of the notes and prompts from the previous week. I was easily able to
pull out the session templates and access the reminders I had made to myself for materials to
prepare and tasks to complete the following week.
The column for extra note space in 2.0 was used for jotting down client quotes, keeping
attendance, recording instances when the session had gone off plan, and once even as a space
where I recorded my own emotional reaction to a session afterwards. The “next steps” space at
the bottom of the page was used for writing reminders for upcoming treatment meetings, song
lyric preparation, songs clients asked me to listen to, materials to bring, emails to send, points to
discuss with the team, and other tasks to complete. These findings further indicated the
usefulness of the template as a systems-based resource, in addition to its original function as a
pre-session tool designated for planning and preparation.
Session Template 3.0 (see Appendix D) was used four times on 2/24/18, and was quickly
updated to Template 3.1, which was used eight times from 2/28/18 – 3/3/18. Templates 3.0 and
3.1 utilized a smaller font size to make more room for handwritten notes, and a decreased line
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size to be more aesthetically pleasing. I also added the categorical label “Main Structured Work /
Optional Free Choice” to the session planning section. One of my individual adolescent clients at
Pelham has taken a strong interest in reviewing the session plan before every session, and he
suggested labeling it that way so that other clients could know they have the option to advocate
for their own interventions. This was great feedback, as I always try to communicate to my
clients that they can always make requests, but that information may not always be understood
fully. With the template, the session plan is clearly outlined for the working therapist to access,
and for interested, high-cognitive functioning clients to access as well, clinical needs and goals
depending.
To improve efficiency, goals and rituals from repeating sessions were typed and printed
in the template to save time spent writing it out before each session. For example, one individual
music therapy session at Pelham Academy always began with the opening ritual of the student
vocally improvising while I supported her on acoustic guitar. T his was typed into a Google Doc
so I would not have to write it out every time. The goals for the dementia groups at Hebrew
Senior Life were constant, so they were also typed into the Template in font size 10 to save
space. These group goals included increase trust, support cognitive functioning, improve
relationships with other group members and increase awareness of environment.
It was important to have the goals pre-printed on every template to serve as a reminder
for the purpose behind every music therapy intervention, especially during the times that sessions
strayed from the plan. As spontaneity is an integral part of music therapy treatment (Bruscia
1998a), the music therapist has a responsibility to adapt interventions depending on client or
group mood or behavior in the present moment. Throughout the entire duration of this research
period with Template 3.0 and 3.1, there were often times when the session plan was not followed
Runninghead:PLANNINGFORSPONTANEITY 24
in-session. For example, in a multi-generational group on 3/2/18 (Template 3.1), only five out of
the planned ten interventions occurred. This was due to the fact that many variables changed in
the moment. The group was significantly larger than I had planned due to a concurrent activity
being cancelled, with new group members arriving after I had already began. Also, a volunteer
joined in last minute playing the piano, allowing me more bodily freedom as I did not need to
play guitar the entire time. When planning for sessions, the music therapist should always keep
in mind that not all may go according to plan. Reflecting on where the plan deviated may provide
valuable insight to the client’s treatment.
The final version of the template (4.0) was used thirty-two times over six weeks, with the
same format and pre-printed goals from previous templates. More pre-printed information was
included for recurring information, with sections left blank if it changed week to week. Groups at
Hebrew Senior Life were always at the same time and in the same location, with the same goals.
I did not need to write detailed progress notes, so the notes section was used for attendance and
brief notes to include in my daily report to my supervisor. The next steps section included pre-
printed “Attendance” and “Update Report.” For Pelham Academy, the session date/time and
location were always left blank due to the changing schedules and locations. Goals for individual
clients were pre-printed as were the initial for group members, as group membership was the
same on a weekly basis. Pre-printed next steps included “� submit progress note.” Handwritten
notes varied from session to session, including observations (BS had low energy throughout
entire group) client quotes (I cried when everyone clapped), reflections (very future-oriented
today) and other notes to reference when writing progress notes and preparing for future
sessions.
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The worksheet-based template was found to be a productive method on which to
efficiently design session plans and provided a resource for gathering and reviewing information.
Furthermore, the template was also useful as a reference tool to support evaluation and
organizational needs for treatment plan development. This template is a viable option for
increasing preparedness and efficiency before, during and after music therapy sessions. A current
limitation of this study is the lack of measurable data on efficiency, but reflections of this writer
indicate that the session template can be used to promote more productive work.
Discussion Findings from this study indicate that it may be beneficial for working music therapists to
use a structured template for each music therapy session facilitated to support more productive
pre-session planning and preparation and post-session processing. The positive consequences of
the model suggest that music therapists may benefit from more succinct preparation and processing
practices and supports the need for future research. Similar to the theory discussed earlier by Beer
(1990), a predictable routine provides familiarity and ease, but will require flexibility to meet the
changes that arise within and between sessions. This applies to the session plan and structure of the
music therapy session itself, and to the routines created by the music therapist to prepare for and
process session occurrences. Opening and closing rituals such as hello and goodbye songs allow for
sessions to be bookended in familiar expectations, signaling time and place to nonverbal clients, and
permitting for easier transitions in and out of session (Kantor & Kruzikova, 2016). When rituals are
repeated across multiple sessions and variables arise, information is provided to the music
therapist about the client and environment that may be beneficial to treatment plan development.
In addition to streamlining the process for session planning, the template also provides
support for writing more detailed progress notes. Therapists can review the session plan, notes taken
Runninghead:PLANNINGFORSPONTANEITY 26
during or after session, and can reflect on when the plan was not followed and why. This information
can provide valuable insight to the client’s affect, orientation and environment. This information may
also provide information on the therapeutic relationship and process. The session template has the
potential to better inform clinical practice by providing a system to utilize for recurring pre- and post-
session tasks such as session planning and documentation. This method provides a resource for
busy professionals to utilize in order to better develop sessions and ensure that clinical goals are
being met throughout the treatment plan.
The significance of this topic is supported by common anecdotal challenges experienced
by music therapists, such as using instruments, props and materials which can be difficult to
transport, locate or share. This is represented on the template in the planning and materials
section. Advance planning will identify needs earlier, allowing more time to gather and transport
materials or supporting easier communication with collaborators. For example, in order to
download songs for sessions at Pelham Academy, I needed to use a specific laptop that was
shared with two other clinicians, and it needed to be connected to the internet by Ethernet cable
in specific locations – it was a very time consuming process. When I was able to get the laptop, I
only had it for a few minutes, but it was easy for me to access which songs I needed because they
were all easily accessible on my template sheets.
Oftentimes music therapists don’t have an office or access to storage space, some use
their cars as an instrument closet. Identifying what equipment to bring is very important,
especially if traveling between sites or sessions. Session planning may be especially useful for
the job-juggling music therapist, for example, a session with the theme of “Autumn Leaves” may
be applicable for preschool settings and in memory care geriatric units, allowing materials to be
used in multiple sessions. Proper planning and procedures can support efficiency and reliability
and can reduce lost time, anxiety and confusion. Practicing a streamlined process for session
Runninghead:PLANNINGFORSPONTANEITY 27
planning and preparation regardless of location or population may increase productivity,
allowing for time saved be better spent on more valuable assignments. This time may be
especially important for a music therapist that has limited or unpaid preparation time.
The template also provides a space for treatment goals, to include when complete pre-
session planning and preparation tasks. Identifying and working towards goals was a significant
element for many models discussed in the literature review section, in mental health counseling
(Nelson-Jones, 2002), education (Wolfe, 1987) and music therapy (Weissman 1983). The
inclusion of treatment goals is one important variable that separates music therapy from
therapeutic music. Having the goals within view for intervention design and also in-session
provided a level of insurance that the clinical goals were being met. Our responsibility is to
ensure that the treatment plan is being followed and the goals and objectives are being met, and
the session plan is designed to support those goals (Wheeler et al., 2005). However, session plans
are rarely followed exactly as written. The balance between spontaneity and structure depends,
as always, on the needs and goals of the clients. My clinical group at Pelham is very high-energy,
with fast-paced movement interventions and loud music. This can be dysregulating for the
clients, so to provide containment and outline expectations we follow the structured interventions
every time. Written check-in to practice mindfulness and regulate energy, verbal check-in to
support group cohesion, low-energy movement intervention to stretch muscles, building to a
high-energy dance/drumming interventions and ending with written check-outs. These
interventions are representative of the previously discussed ARC model, which suggests using an
opening check-in, a modulation activity, a structured activity, and a closing check-out (Blaustein
& Kinniburgh, 2010).
Runninghead:PLANNINGFORSPONTANEITY 28
Conclusion
Future research on this topic should aim to involve and collaborate with other music
therapists, such as considering their perspectives and habits of session planning and processing,
or inviting them to use the template-based system and gathering information on what worked and
what didn’t. As the intention of this study was to create a universal method for use with varied
populations and locations, future research may consider supporting a series of templates to
provide options that are better suited for specific clinical needs or locations. Expansions of this
topic may consider measuring efficiency through time spent in pre-session planning and post-
session processing. Future research may consider moving towards a better understanding of how
to measure productivity in therapy. This project is intended to contribute to the literature
surrounding session structure, clinical planning and preparation skills, post-session processes and
efficiency in music therapy. Ultimately, the findings and results of this method are valuable
considerations in developing a better understanding of structure in and surrounding music
therapy sessions and promoting a more productive clinical practice in music therapy work.
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References
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Appendices
Appendix A: Theoretical Model Comparison
Author Session Structure Sections
Wheeler et al 2005 Warm-Up / Introductory Main Part Closing / Wrap-Up
Nelson-Jones 2002
Preparing Middle Ending
Starting
Blaustein & Kinniburgh
2010
Opening check-in Structured activity Closing check out
Modulation Activity Free Choice Activity
Bonny 1978
Preliminary conversation, establish rapport
Music Listening period Integrate/Review experiences Relaxation, Support
concentration
Stephens 1984
Warm-Up Main Phase Closure Verbal Discussion (Check-
in)
Gardstrom 2007
Introductory Discussion Improvisation
Verbal or Musical Closure Verbal Check-In Brief Discussion
Sound Vocabulary Verbal Processing
Ridder-Mette 2004
Focus attention Dialogue Conclusion
Regulate arousal
Beer 2011
Setting physical environment
Meet clients energy or present alternative Closure
Create atmosphere of trust and safety
Establish a relationship in the music Notes
Create experience geared towards needs and interests Work Planning
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Appendix B: Session Template 1.0
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Appendix C: Session Template 2.0
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Appendix D: Session Template 3.0
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Appendix E: Session Template 4.0 Sample